Chemoprevention of Colorectal Cancer

Chemoprevention of Colorectal Cancer

Although colorectal cancer (CRC) screening has reduced the incidence of and mortality from CRC, chemoprevention strategies have the potential to further reduce CRC incidence and mortality. Chemoprevention agents might be used for average-risk as well as high-risk groups, and to prevent CRC recurrence after therapy. CRC chemoprevention agents that have been studied include aspirin, nonaspirin nonsteroidal anti-inflammatory drugs, statins, agents that target metabolic pathways, and vitamins and minerals.

In this article, HIP Investigator Dr. Jennifer Weiss along with Dr. Bryson Katona reviewed the prospect of chemoprevention of colorectal cancer, results from preclinical and human studies, challenges, and future directions.

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Child patient hospitalized

Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Children with medical complexity (CMC) have lifelong, complex chronic conditions (CCCs) associated with multimorbidity, severe functional limitations, myriad health care needs, and high resource use. Although hospitalizations have been a long-standing measure of a potentially avoidable CMC health service, little is known about the opportunity to influence the hospitalization risk from an ED visit. Therefore, HIP Investigator Dr. Ryan Coller et al. identified factors associated with admission within ED encounters and to quantified both the overall ED admission rate for CMC and admission rate variation across children's hospitals.

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Holding hands

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

Fused comparative intervention scoring for heterogeneity of longitudinal intervention effects

With the growing cost of health care in the United States, the need to improve efficiency and efficacy has become increasingly urgent. There has been a keen interest in developing interventions to effectively coordinate the typically fragmented care of patients with many comorbidities. Evaluation of such interventions is often challenging given their long-term nature and their differential effectiveness among different patients. Furthermore, care coordination interventions are often highly resource-intensive. Hence there is pressing need to identify which patients would benefit the most from a care coordination program. In this work, Dr. Jared Huling and HIP Investigators Dr. Menggang Yu and Dr. Maureen Smith introduced a subgroup identification procedure for long-term interventions whose effects are expected to change smoothly over time.

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Looking over papers

A robust approach to sample size calculation in cancer immunotherapy trials with delayed treatment effect

A robust approach to sample size calculation in cancer immunotherapy trials with delayed treatment effect

A group of authors including HIP Investigator, Dr. Menggang Yu et al. presents an approach to calculate sample size based on a maximin efficiency robust test. Both theoretical derivations and simulation results show the proposed approach can guarantee the desired power in worst case scenarios and often much more efficient than existing approaches. Application to a real trial design is also illustrated.

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Doctors working around table

Optimal treatment assignment to maximize expected outcome with multiple treatments.

Optimal treatment assignment to maximize expected outcome with multiple treatments.

When there is substantial heterogeneity of treatment effectiveness, it is crucial to identify individualized treatment assignment rules for comparative treatment selection. HIP Investigator, Dr. Menggang Yu et al. propose an outcome weighted learning method that extends estimating individualized treatment rules to multi‐treatment case by using a vector hinge loss as a target function. Consistency of the resulting estimator is shown in the article.

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Doctor with arms crossed and blue ribbon on medical coat

Primary care colorectal cancer screening correlates with breast cancer screening

Primary care colorectal cancer screening correlates with breast cancer screening

In a retrospective cohort study, Dr. Jennifer Weiss et al. examined 90 primary care providers (PCPs) and over 33,000 patients eligible for colorectal cancer (CRC) screening to determine whether PCP colorectal cancer screening practices correlate with other preventive and chronic care needs. The investigators looked at CRC screening rates in comparison to five other PCP quality metrics—breast cancer screening, cervical cancer screening, HgbA1c and LDL testing, and blood pressure control—and found that PCP CRC screening rates have a strong correlation with breast cancer screening rates and a weak correlation with the other metrics. These results indicate that efforts to increase PCPs' CRC screening rates could be bundled with breast cancer screening improvement interventions to increase their impact.

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CT Scan

Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates.

Insurance Coverage for CT Colonography Screening: Impact on Overall Colorectal Cancer Screening Rates.

Dr. Maureen Smith et al. compared colorectal cancer (CRC) screening rates for patients with and without insurance coverage for CT colonography. Using longitudinal electronic health record data, the investigators found that among patients who became due for CRC screening, there was a 48% greater likelihood of them getting screened by any method if they had insurance coverage for CT colonography when compared to those who did not have insurance coverage.

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Ultrasound machine

Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma

Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma

In this study, Dr. Ryan Schmocker et al. examined patterns of preoperative endoscopic ultrasound (EUS) for pancreatic adenocarcinoma and the impact on downstream treatment. The investigators used the SEER-Medicare database to conduct the study and found the factors most associated with receipt of EUS were: earlier year of diagnosis, SEER area, and an NCI or academic hospital. EUS was associated with a longer time to surgery and higher number of staging tests.

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technician talking to patient before scan

PCP adoption of CT colonography for colorectal cancer screening

PCP adoption of CT colonography for colorectal cancer screening

In a recent study by Dr. Jennifer Weiss et al. to examine factors influencing primary care provider adoption of CT colonography (CTC) for colorectal cancer screening, the authors linked survey responses with electronic health record data and found that substantial variation in the use of CTC for screening existed among primary care providers and clinics.

Primary care providers were more likely to recommend CTC for screening if they specialized in Internal Medicine, perceived that it was effective in reducing mortality from colorectal cancer, or thought that CTC had a higher number of perceived advantages.

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Doctor and female patient talking

Variation in the types of providers participating in breast cancer follow-up care

Variation in the types of providers participating in breast cancer follow-up care

Dr. Heather Neuman et al. aimed to describe the types of providers participating in early follow-up care of older breast cancer survivors. Using the SEER-Medicare database, investigators found 80% of follow-up care was with a medical oncologist, 46% with a surgeon, and 39% with a radiation oncologist after radiation treatment. Patients with larger tumor size, positive axillary nodes, estrogen receptor-positive status, and chemotherapy treatment were more llikely to have medical oncology follow-up.

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